Healthcare Provider Details

I. General information

NPI: 1114067584
Provider Name (Legal Business Name): DONNA LYNNE DOVER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29525 ROAD 217
EXETER CA
93221-9720
US

IV. Provider business mailing address

29525 ROAD 217
EXETER CA
93221-9720
US

V. Phone/Fax

Practice location:
  • Phone: 559-594-8072
  • Fax:
Mailing address:
  • Phone: 559-492-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW 60118600
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW71009
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP 00005969
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCI11280418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: